<form action="perso.php" method=post>
<table>
<tr>
<td><input name="Block1" size=10 maxlength=11></td>
<td><input name="Block2" size=6 maxlength=7></td>
<td><input name="Block3" size=6 maxlength=7></td>
<td><input name="Block4" size=1 maxlength=1></td>
</tr>
<tr>
<td align=center colspan=4><INPUT TYPE="SUBMIT" VALUE="  Submit  "></td>
</tr>
</table>
</form>

